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It has only been the last 20-30 years that medical research has understood the mechanisms by with these drugs work. As science identifies the complex role inflammation plays in many conditions, the role of indomethacin expands. To understand how Indocin treats gout, understanding the inflammatory response is necessary. One of the direct local effects of prostaglandins includes vasodilation, meaning enlargement of the blood vessels, which increases circulation to the area.
When the blood vessels are bigger, more blood can be delivered. This carries more white blood cells and proteins to heal the inflammation. Gastrointestinal irritation, which may range from stomach upset to active bleeding, is not uncommon. Blocking that action can increase constriction of blood vessels and worsen symptoms. Cardiovascular risks have been identified in people who have had a previous heart attack.
Both Cox 1 and Cox 2 act as vasodilators in the kidneys. When kidney function becomes compromised for any reason dehydration, atherosclerotic disease, other drug side effects, diabetesprostaglandins dilate the vessels in the kidney to compensate for the decrease in renal blood flow.
Monitor blood glucose levels of patients taking indomethacin during glucagon treatment. Glyburide: NSAIDs may enhance hypoglycemia in diabetic patients via inhibition of prostaglandin synthesis, which indirectly increases insulin secretion. Gold: Due to the inhibition of renal prostaglandins by NSAIDs, concurrent use with other nephrotoxic agents, such as gold compounds, may lead to additive nephrotoxicity. Guanabenz: NSAIDs may decrease the effect of antihypertensive agents through various mechanisms, including renal and peripheral vasoactive pathways.
Guanfacine: NSAIDs may decrease the effect of antihypertensive agents through various mechanisms, including renal and peripheral vasoactive pathways. Haloperidol: In a small study, during concomitant administration of haloperidol with indomethacin, adverse reactions, such as drowsiness and other effects, to haloperidol appeared to be intensified. Although more data are needed to confirm these findings, clinicians should administer indomethacin to patients stabilized on haloperidol cautiously.
The effect of other NSAIDs on haloperidol are unknown. Heparin: An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs NSAIDs. Hydralazine: If nonsteroidal anti-inflammatory drugs NSAIDs and an antihypertensive drug are concurrently used, carefully monitor the patient for signs and symptoms of renal insufficiency and blood pressure control.
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Please log in or subscribe to gain access. This assists in lowering swelling and pain. Indocin has other uses as well such as being able to relieve pain caused by inflammation of the pouch that surrounds the heart as well as additional conditions.
The goal is for you to do what you can in order to keep any risks to a minimum. The first thing you want to do is tell your doctor your entire medical history. The reason for this is because they need to know if prescribing you this medication can cause problems with other conditions you might have.
Other options might be better for you to use in some cases.
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However, even short-term NSAID therapy is not without risk. The Coxib and traditional NSAID Trialists' Collaboration meta-analysis of randomized controlled trials demonstrated an approximately two-fold increase in hospitalizations for heart failure in COX-2 selective-treated patients and nonselective NSAID-treated patients compared to placebo-treated patients.
In a Danish National Registry study of patients with heart failure, NSAID use increased the risk of MI, hospitalization for heart failure, and death. Additionally, fluid retention and edema have been observed in some patients treated with NSAIDs.
Use of indomethacin may blunt the CV effects of several therapeutic agents used to treat these medical conditions e. Avoid the use of INDOCIN in patients with severe heart failure unless the benefits are expected to outweigh the risk of worsening heart failure.
If INDOCIN is used in patients with severe heart failure, monitor patients for signs of worsening heart failure.
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Antithrombin III: An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs NSAIDs. Monitor clinical and laboratory response closely during concurrent use. Antithymocyte Globulin: An increased risk of bleeding may occur when NSAIDs are used with agents that cause clinically significant thrombocytopenia, such as antithymocyte globulin.
Patients receiving these drugs together should be monitored closely for bleeding. Apixaban: An additive risk of bleeding may be seen in patients receiving anticoagulants in combination with other agents known to increase the risk of bleeding such as nonsteroidal antiinflammatory drugs NSAIDs. Aprepitant, Fosaprepitant: Use caution if indomethacin and aprepitant are used concurrently and monitor for a possible decrease in the efficacy of indomethacin.
After administration, fosaprepitant is rapidly converted to aprepitant and shares the same drug interactions. Indomethacin is a CYP2C9 substrate in vitro, and aprepitant is a CYP2C9 inducer.
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I normally take indomethacin 75mg 2x day for acute gout.
I agree I don't think rebound would develop that quickly if you hadn't ever taken it before, and its a much more unlikely med to cause it.
Blunting of the antihypertensive effect of beta-adrenoceptor blocking agents by non-steroidal antiinflammatory drugs including INDOCIN has been reported.
Moexipril: In the low-renin or volume-dependent hypertensive patient, prostaglandins play an important role in the hypotensive effects of ACE inhibitors.
The risk or severity of adverse effects can be increased when Indomethacin is combined with Zoledronic acid. The risk or severity of adverse effects can be increased when Indomethacin is combined with Zomepirac. Indomethacin may decrease the excretion rate of Zorubicin which could result in a higher serum level. US5310936 Akbarpour F, Afrasiabi A, Vaziri ND: Severe hyperkalemia caused by indomethacin and potassium supplementation.
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Where can I get more information?
Animal studies show risk and human studies not available or neither animal nor human studies done.
For this reason, indomethacin should not be used right before or after heart bypass surgery.